Tweaking the accreditation system
Dr. Mary Beth Leininger plans to stand before the American Veterinary Medical Association’s Board of Governors next month in hopes of reclaiming her seat on the Council on Education (COE).
The July 7 hearing, scheduled ahead of the AVMA Convention in Boston, will be closed to the public despite Leininger's request to permit AVMA-member access.
The former AVMA president and prominent figure within organized veterinary medicine was kicked off the COE in March 2014, after publicly suggesting that the 20-member volunteer accrediting body she worked for did not have the resources to evaluate foreign schools without neglecting the 30 veterinary medical programs on U.S. soil.
Leininger isn’t alone in her concerns. For years, a faction of the veterinary profession has tried to compel the AVMA to cease foreign accreditation, ease its grip on the COE and roll back the accreditation body’s acceptance of distributed learning. Under that model, students rotate through private practices rather than a university-run veterinary teaching hospital to gain the clinical skills needed to graduate.
Leininger was removed because some AVMA leaders viewed her opinions as conflicting with her role as a COE member — an accusation she flatly rejects. Contacted for an interview, Leininger declined to share her thoughts on the hearing.
“Because the process is ongoing, I’m not going to comment at this time,” she stated.
Her case marks a sea change in the guarded realm of veterinary accreditation. AVMA dismissals, though rare, usually are quietly conducted. Not so for Leininger, whose situation has captured the profession’s attention and the eye of the U.S. Department of Education (USDE).
At the same time, accreditation debate brews from within the AVMA's policy making ranks. Just days after Leininger's hearing, the House of Delegates will gather in Boston ahead of the AVMA Annual Convention. On the agenda are three resolutions designed to transform how the COE operates, from its selection processes to severing the AVMA’s purse strings (see chart).
“We’re all waiting to see what happens,” said Dr. Eric Bregman, longtime COE critic and New York State Veterinary Medical Society (NYSVMS) past president.
Bregman, a practitioner who splits his time between Florida and Brooklyn, is part of a grassroots movement intent on overhauling how the COE functions. The COE has operated under the AVMA umbrella since the 1950s, when it became USDE-recognized as the nation’s programmatic accreditor of veterinary education.
For more than half a century, the COE attracted little attention.
That changed a decade ago with the emergence and eventual accreditation of Western University of Health Sciences’ veterinary college, the nation’s first to forgo a traditional teaching hospital in favor of distributed learning. Around the same time, the COE began accrediting a slew of foreign veterinary schools, acting on an AVMA-backed mandate to spread its “gold standard” of veterinary accreditation internationally.
The COE has accredited 14 programs outside the United States and Canada, starting with the recognition of the University of Utrecht in the Netherlands in 1973. (Debate exists about whether the AVMA's professed 40-year history accrediting foreign schools is accurate; Utrecht's "recognition" initially was not synonymous with "accreditation" but has since evolved in that direction). It was 25 years before another foreign program earned the distinction — the University of London's Royal Veterinary College in 1998. France's VetAgro Sup was the latest to be accredited by the COE in 2013.
Critics have expressed concerns that the evaluating body has bowed to AVMA political pressure rather than the welfare of U.S. veterinary education. Proponents for change contend that the AVMA maintains too much influence over the COE, which is supposed to operate autonomously. That relationship has spurred allegations of cronyism, political power mongering and conflicts of interests.
AVMA leaders have staunchly defended the status quo, even as criticisms of the system draw attention beyond the veterinary community. In December 2014, USDE auditors with the power to strip the COE of its domestic accrediting authority scolded the organization for ignoring critics and referenced the nearly 900 letters of complaint the agency had received.
Panelists with the USDE’s National Advisory Committee on Institutional Quality and Integrity (NACIQI) also honed in on the dismissals of Leininger and Dr. William Kay, another former COE member who was ousted in 2007.
Both discharged veterinarians testified before the NACIQI, airing their concerns about the COE accreditation system.
Federal officials appeared taken aback that the COE hadn’t made them aware of such personnel issues. “I’m a little troubled by the removal of commissioners for cause and why that was not relayed (to USDE staff),” NACIQI member Arthur Rothkopf expressed at the meeting.
USDE staff analyst Jennifer Hoang added with surprise, “This is the first I’ve heard about it.”
Ultimately, the COE was granted a temporary extension on its status as an accrediting body with orders to make significant fixes within a year, including mending its rift with critics. NACIQI member Bill Pepicello warned AVMA and COE officials that he’d be watching for “evidence that you will make a better effort to listen to people.”
Strengthening the firewall
Since then, the AVMA has held several “listening sessions,” where members of the profession are invited to air their concerns before a panel of attentive but largely silent COE members.
Critics note that the listening sessions are not well-advertised, drawing just 20 to 50 attendees. Many session-goers are familiar faces within the COE controversy.
“The cynic in me finds the timing of the AVMA’s listening to conveniently coincide with the scrutiny that the USDE … is placing on the COE,” Dr. Greg Nutt, a practitioner in Canton, Georgia, wrote in response to an AVMA blog on the topic.
The April 11 post advertised key ways the AVMA is working to keep the COE independent and at arm’s length. AVMA board members will no longer go on COE site visits or sit in on COE meetings.
Officials also set aside $10,000 in the AVMA’s budget to retain outside legal counsel for the COE rather than share an attorney.
Another change involves the creation of a COE selection committee charged with reviewing new candidates. And, according to a Journal of the American Veterinary Medical Association article, colleges seeking U.S. accreditation will pay half of the annual costs tied to evaluating the program and all site visit costs. The Association of American Veterinary Medical Colleges, which now will play a greater role on the COE, also will chip in for expenses.
The mere public mention of the COE's budget — normally kept private, even from COE members — surprised some veterinarians.
“We’ve listened,” the blog states. “AVMA leadership and the COE understand that members are concerned about the strength of the firewall between the COE and AVMA Board of Directors. Both groups felt these actions were necessary to reassure members that although the COE is under the umbrella of the AVMA, its actions and decisions are not influenced by AVMA leadership.”
The news was met with tentative applause.
“Delighted to learn that the AVMA is responding to those who feel that their profession is not served by an AVMA whose COE is not truly independent of AVMA influence,” wrote Dr. Leland Charmichael, a veterinary virologist at the Baker Institute of Animal Health at Cornell University.
“Kudos to the Board of Directors for listening to their constituents,” added Dr. Robert Cherenson, a former COE member and practitioner in Turlock, California. “This is a great beginning; and I emphasize beginning. I believe there remains opportunity to strengthen the function of the COE and genuinely develop autonomy and independence.”
He and others point out that the AVMA Board of Directors still retains control over who participates in the COE selection committee and the COE budget. The Board also has the final say over whether foreign accreditation should continue indefinitely.
“I believe this is inappropriate,” Cherenson wrote. Dr. Carl Darby also expressed concerns that are lingering.
“So if AVMA board members were on site visits as observers, who paid for their travel expenses?” wrote Darby, a practitioner in Seneca Falls, New York. “If the AVMA paid, I think this is an unacceptable use of AVMA member dollars. So AVMA, please answer this question.”
Officials at AVMA did not reply to the comments, fueling ongoing criticisms that leaders with the organization are unresponsive. “Great question, but good luck getting an answer to that one, Carl,” Nutt quipped.
Regulatory change on horizon
Ultimately, any role the COE continues to play in the accreditation of foreign schools might be out of the profession’s hands.
USDE officials are looking for an accrediting body to ascertain whether foreign veterinary schools are worthy of accessing Title IV federal student aid, including Federal Direct Perkins Loans. Right now, the COE accreditation isn’t a gateway to Title IV loans, but its approval grants the students of accredited schools access to professional loans under Title VII of the U.S. Public Health Act.
The job of Title IV eligibility traditionally has fallen on the USDE’s National Committee on Foreign Medical Education and Accreditation, which works to ensure foreign programs are comparable to U.S. programs.
That will change July 1, when USDE plans to instead award such funds to U.S. citizens enrolled in foreign veterinary schools only if they’re attending a program deemed acceptable by an accreditor — a yet-to-be-named body that first must be approved by the department.
The AVMA wants the COE to be that agency. The Royal College of Veterinary Surgeons, which accredits veterinary schools in the United Kingdom and elsewhere, also wants the job.
Either way, AVMA officials say the COE accreditation will continue to hold the keys to professional loans, designed to cover educational expenses beyond the limits of Title IV aid.
Graduating from a COE-accredited veterinary medical program (or passing a foreign graduate equivalency exam) also is a requisite for state licensure.